New York Times. Dec, 2022.
Paul Goldfinger. MD, FACC. Blogfinger.ne
The New York Times (12/15, Abelson) reports the Agency for Healthcare Research and Quality released study results that discovered “as many as 250,000 people die every year because they are misdiagnosed in the emergency room.” The study “estimates roughly 7.4 million people are inaccurately diagnosed of the 130 million annual visits to hospital emergency departments in the United States,” and “some 370,000 patients may suffer serious harm as a result.”
However, “the researchers largely relied on studies conducted outside the United States, in countries like Canada, Spain and Switzerland, to come with up with their overall estimate of error and harm rates.”
I am worried about ER care. Not only are they understaffed, but they are making fatal mistakes as described above. Whenever I go to an ER for myself or for family, I find that quality is being compromised in one way or another. I dread having to go to an ER.
I don’t like anecdotes, but they can be instructive. Years ago medical journals would publish case reports, and I had a few accepted myself.
So I took a relative to a local ER a few years ago with a painful knee. She was seen by a nurse practitioner who barely explained who he was. I asked if a doctor would see her, and he said, “I can do what a doctor can.” But he couldn’t….his history taking skills were superficial and ill informed, and his physical examination skills were poor. He failed to review her medications and he ordered the wrong test. In the end he missed the correct diagnosis which was not obvious, and the correct diagnosis and treatment were discovered by chance and thanks partly to my unmasking my identity and pushing for a happy ending.
Such “doctors” don’t know how to dig deep and have high indices of suspicion when evaluating patients with complex situations.
There is good reason why doctors are in training and school for much longer than “physician extenders” who are utilized wrong and are part of a bottom line oriented healthcare industry where efficiency and shortcuts prevail as top priorities. Thus mistakes are made.
Too many doctors are employees rather than the architects of their practices. This is part of the problem where errors are made. Many doctors are leaving practice or looking for new ways out, such as working as concierge physicians. Burnout, early retirement, and suicide are more common.
Give physicians the driver’s seat again. America can afford high quality medical care for all, but that goal is sinking now.
There is a link above to the Times piece, with hundreds of comments, many are very good.
Here is a portion of one: “And for a final answer to what is wrong with the patient, I live by the mantra that the patient will always tell you what is wrong. But that requires time to ask questions and talk to the patient, something else that is a disappearing art. The doctor patient relationship is essential to good care, but is a vanishing species, being replaced with batteries of tests that may add confusion rather than clarity. On the other hand, hospitals get paid well for testing and less for letting doctors do their jobs.”
MILT JACKSON. “Emily”
New York-Presbyterian Medical Center of Queens [NY]. They initially placed a small ultrasound (?) panel on my chest and very quickly sent me for x-rays and a more definitive ultrasound, both of which were adjacent to the ER. I think I might have gotten the IV after the x-ray, though things happened so quickly it is hard to recall. I had a saddle clot that was deemed very dangerous though I did not appreciate it at the time. Clot buster medications were placed in my lungs via a neck vein by two wires. I was in the hospital for 5 days. Several of the staff mentioned I looked much better than my chart diagnosis and my home doctor was completely appalled when reading the discharge papers. The highlight was when a nurse entered and declared, “Mr. Fox, you look much younger than your age [73 at that time].”
David. That is the sort of difficult diagnosis which may be missed by inexperienced ER staffers. I am impressed by that and also that they were confident enough to start anticoagulants before proceeding with testing. Tell us the name of that hospital.
Nearly 3 years ago I passed out while making my bed. The cause was a massive blood clot in my lungs. I fortunately awoke feeling OK, but had an ambulance take me to the local hospital.
The ER diagnosed me in about 30 seconds and placed me on anticoagulants. Their diagnosis was confirmed by ultrasound of my lungs and right leg. I will always be grateful to the skill of these doctors.